Akademik Veri Yönetim Sistemi
33rd Meeting of the European Society of Thoracic Surgeons, Budapest, Macaristan, 25 - 27 Mayıs 2025, ss.161-162, (Özet Bildiri)
Background
Spread through
air
spaces
(STAS) is an independent risk factor
for
recurrence-free
survival
(RFS) and overall
survival
(OS). This study evaluates
the
impact
of STAS on survival outcomes
in patients with early-stage
lung
adenocarcinoma
(AC).
Methods
439 patients with T1-2N0 stage lung cancer who underwent surgery and had STAS assessment between 2016-2024, were divided into STAS-Present (STAS-P) and STAS-Absent (STAS-A) groups for initial statistical analyses. Further analyses focused exclusively on the AC (N=296) cohort. Survival analyses were performed using the Kaplan-Meier method and log-rank test, evaluating subgroups based on gender, smoking history, surgical approach (lobar/sublobar), tumor subtype, pathological T stage (pT), lymphovascular invasion (LVI), perineural invasion (PNI), visceral pleural invasion (VPI), and adjuvant therapy.
Results
Among 296 patients with AC, 111 (37.5%) were STAS-P. Significant differences were observed between STAS groups in tumor subtype (lepidic vs. acinar+papillary vs. micropapillary+solid), pT, LVI, and VPI (p<0.001, p=0.005, p<0.001, and p=0.028, respectively). Both OS and RFS were better in the STAS-A group (p=0.03 and p=0.03, respectively).
COX regression model showed STAS presence was associated with a Hazard Ratio (HR) of 2.038 (p=0.033) for OS and 1.949 (p=0.033) RFS.
Patients were further stratified into four subgroups:
Group 1: STAS-A, tumor size <2 cm
Group 2: STAS-A, tumor size 2-5cm
Group 3: STAS-P, tumor size <2 cm
Group 4: STAS-P, tumor size 2-5cm
Significant differences were revealed in OS (p=0.026) and RFS (p=0.011) among the groups. COX regression model yielded
the following HR values (compared to Group 1):
OS: Group 2: HR=3.247 (p=0.027)
Group 3: HR=3.331 (p=0.047)
Group 4: HR=4.385 (p=0.005)
RFS: Group 2: HR=2.835 (p=0.025)
Group 3: HR=2.362 (p=0.12)
Group 4: HR=4.233 (p=0.02)
Conclusion
These findings highlight the importance of STAS as a prognostic factor in clinical decision-making as STAS is associated with poorer RFS and OS in patients with T1-2N0 AC, particularly when combined with larger tumor sizes. Also, the similarity of the overall survival outcomes between the patients with STAS-P tumors ≤2 cm and those with STAS-A tumors >2 cm was striking. This similarity may suggest that STAS presence may negate the expected favorable prognosis associated with smaller tumor size.
Travis WD, Eisele M, Nishimura KK, Aly RG, Bertoglio P, Chou TY, Detterbeck FC, Donnington J, Fang W, Joubert P, Kernstine K, Kim YT, Lievens Y, Liu H, Lyons G, Mino-Kenudson M, Nicholson AG, Papotti M, Rami-Porta R, Rusch V, Sakai S, Ugalde P, Van Schil P, Yang CJ, Cilento VJ, Yotsukura M, Asamura H; Members of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Members of the Advisory Boards, and Participating Institutions of the Lung Cancer Domain. The International Association for the Study of Lung Cancer (IASLC) Staging Project for Lung Cancer: Recommendation to Introduce Spread Through Air Spaces as a Histologic Descriptor in the Ninth Edition of the TNM Classification of Lung Cancer. Analysis of 4061 Pathologic Stage I NSCLC. J Thorac Oncol. 2024 Jul;19(7):1028-1051. doi: 10.1016/j.jtho.2024.03.015. Epub 2024 Mar 18. PMID: 38508515.